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Eur J Cardiothorac Surg 2001;19:806-810
© 2001 Elsevier Science NL

Successful management of Brucella mellitensis endocarditis with combined medical and surgical approach

^a Departments of Cardiology and Cardiothoracic Surgery, University of Thessaly, Larissa, Greece
^b Department of Cardiac Surgery, Hippokration Hospital, Athens, Greece

Received 2 August 2000; received in revised form 26 February 2001; accepted 21 March 2001.

Corresponding author. 8 Androu Street, Athens 18345, Greece. Tel.: +3-01-9560815
e-mail: l_hadjinikolaou{at}hotmail.com

Objectives: Brucella endocarditis is an underdiagnosed complication of human brucellosis, associated with high morbidity and mortality. We report the successful management of a number of cases of Brucella mellitensis endocarditis. Patients and methods: Seven consecutive cases of Brucella mellitensis endocarditis were treated over the last 20 years, based on high suspicion of the disease at first place. The early suspicion of Brucella endocarditis relied on medical history and a standard tube agglutination titer 1:320. Blood and/or cardiac tissue cultures were positive in all patients, but available late following surgery. All patients were successfully treated with a combination of aggressive medical and early surgical therapy. All affected valves were replaced within 1 week from admission (five aortic and three mitrals). Medical treatment included co-trimoxazole, tetracyclines and streptomycin, before surgery, followed by co-trimoxazole and tetracyclines for a median of 12 months (range: 3–15 months) after surgery until the titers returned to a level 1:160. Results: There were neither operative deaths nor recurrence of infection. One patient died two years after the operation due to massive cerebrovascular accident. Ten-year survival was 85.7±13.2%. Conclusion: Although Brucella mellitensis endocarditis is a rare entity, its optimum management should be a combination of aggressive medical treatment and early surgical intervention, based on high degree of suspicion in areas with high incidence of the disease.

Key Words: Brucella melitensis • Brucella endocarditis • Brucella complications

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